Biederman J, Faraone S V, Wozniak J, Monuteaux M C
Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Boston, Massachusetts 02114-3139, USA.
Biol Psychiatry. 2000 Dec 1;48(11):1037-44. doi: 10.1016/s0006-3223(00)00906-9.
Bipolar disorder has emerged as a risk factor for substance use disorders (alcohol or drug abuse or dependence) in youth; however, the association between bipolar disorder and substance use disorders is complicated by comorbidity with conduct disorder. We used familial risk analysis to disentangle the association between the three disorders.
We compared relatives of four proband groups: 1) conduct disorder + bipolar disorder, 2) bipolar disorder without conduct disorder, 3) conduct disorder without bipolar disorder, and 4) control subjects without bipolar disorder or conduct disorder. All subjects were evaluated with structured diagnostic interviews. For the analysis of substance use disorders, Cox proportional hazard survival models were utilized to compare age-at-onset distributions.
Bipolar disorder in probands was a risk factor for both drug and alcohol addiction in relatives, independent of conduct disorder in probands, which was a risk factor for alcohol dependence in relatives independent of bipolar disorder in probands, but not for drug dependence. The effects of bipolar disorder and conduct disorder in probands combined additively to predict the risk for substance use disorders in relatives.
The combination of conduct disorder + bipolar disorder in youth predicts especially high rates of substance use disorders in relatives. These findings support previous results documenting that when bipolar disorder and conduct disorder occur comorbidly, both are validly diagnosed disorders.
双相情感障碍已成为青少年物质使用障碍（酒精或药物滥用或依赖）的一个风险因素；然而，双相情感障碍与物质使用障碍之间的关联因与品行障碍共病而变得复杂。我们采用家族风险分析来厘清这三种障碍之间的关联。
我们比较了四组先证者的亲属：1）品行障碍 + 双相情感障碍，2）无品行障碍的双相情感障碍，3）无双相情感障碍的品行障碍，以及4）无双相情感障碍或品行障碍的对照受试者。所有受试者均通过结构化诊断访谈进行评估。对于物质使用障碍的分析，采用Cox比例风险生存模型来比较发病年龄分布。
先证者中的双相情感障碍是亲属中药物和酒精成瘾的一个风险因素，独立于先证者中的品行障碍，品行障碍是亲属中酒精依赖的一个风险因素，独立于先证者中的双相情感障碍，但不是药物依赖的风险因素。先证者中的双相情感障碍和品行障碍的影响相加可预测亲属中物质使用障碍的风险。
青少年中品行障碍 + 双相情感障碍的组合预示亲属中物质使用障碍的发生率特别高。这些发现支持了先前的结果，即当双相情感障碍和品行障碍共病时，两者都是有效诊断的障碍。
